Teristella

We used Meditech and it worked fine. As I said, it was not interfaced.

Who took the shipment to the OR anyway? The blood supplier? Or do they drop it off with someone in the facility? If your supplier's couriers are taking products straight to the OR, you would probably want to address that with the supplier to prevent it from happening in the first place.

Copying a reply I made to another post concerning this, and I'll add some more info as well. We used the Haemonetics Emerge kiosk for our trauma bay at my previous hospital... it worked well as long as the nurses were trained, but our trauma department had difficulties with high turnover. If they aren't trained well they ended up panicking and opening the fridge and not scanning out the units. As long as there was only one trauma at a time we could track everything easily; if not, and we were not familiar with the nurse working the kiosk, we would go down to manage it ourselves. A lot of it did depend on the physicians as well, some were very vocal about getting blood quickly and would bully the nurses into shortcuts. The Emerge will let nurses scan a patient label to link products to (they have to scan it once for each type of product and then scan out the required number of units). This was not interfaced to our LIS but we could find the patient name based on the account number they scanned. The computers in the blood bank had software that linked to the kiosk and would alert us when the fridge was opened, so we could monitor what was removed. With the Emerge you have to program what types will be in the fridge, and as I recall, they did not allow for more than two choices per product type. That meant when we first started storing plasma there, the nurses had to select plasma, then select AB pos or AB neg. You could not remove the Rh on plasma and it drove us insane. We would make every effort to store only AB pos there, and train the nurses to only select AB pos... but the AB neg option was still there, and if they selected it, the kiosk informs them there are no units available and to contact the blood bank! You can imagine this got us a lot of frantic phone calls... we also ran into this problem when we switched to using group A liquid plasma and we would have to request only Rh pos from our supplier to try to avoid this problem. Eventually we were storing 2 O neg packed cells and 6 A liquid plasmas, plus 2 pediatric units on the bottom shelf. We kept two thawed AB plasmas in the blood bank for pediatric use which they were to call us for. The Emerge also does not have any checks in place to question the staff of the gender/age of the patient... for this reason my blood bank supervisor chose not to store O positive units in the kiosk. We surveyed a lot of hospitals in our system and many did keep O positive in the fridge. I was personally of the opinion that we needed O positive units down there, and had suggested that we get two bins, one pink and one blue, with signs on the top describing the indications. The trauma docs did not want the responsibility of telling the nurses operating the kiosk which type to grab so it was up to the RNs. We were a level 2, however, so the majority of our traumas were using O positive. If you were a level 1, I think you'd have to decide this for yourself -- do you let them figure it out or only give them the option of O negative? We were always so short on O negatives that we reduced the number of units in the fridge to 2, so that when they all panicked and transfused them to a 70 y/o male (they were supposed to call us for O positive), we wasted fewer Rh negs! They rarely gave products from the fridge unless it was a massive transfusion, and we would bring them the O positive (we kept 6 pre-labeled in the blood bank) with a platelet for their first batch, to use with the plasmas from the fridge. They could move the plasmas into the cooler we bought with the O pos and haul it off to CT or OR or wherever. This seems awfully long so I really hope it makes a little bit of sense. Please feel free to ask any questions, I probably missed some important points.

Yes, I think getting your facility's quality/risk management department involved might be a good idea. The idea of sending a report to the FDA might prompt them to get involved.

That is quite possibly the most terrifying idea I have heard of a department thinking is an alright thing to do! I do not have any stories to share (thankfully?!) but I feel like there are numerous regulations you could cite, CAP and otherwise. Joint Commission would probably have a cow as well.

We used the Emerge for our trauma bay at my previous hospital... it worked well as long as the nurses were trained, but our trauma department had difficulties with high turnover. If they aren't trained well they ended up panicking and opening the fridge and not scanning out the units. As long as there was only one trauma at a time we could track everything easily; if not, and we were not familiar with the nurse working the kiosk, we would go down to manage it ourselves. A lot of it did depend on the physicians as well, some were very vocal about getting blood quickly and would bully the nurses into shortcuts.

We do not use the liquid plasma on 'regular' patients (i.e. non-emergent) due to the following published in the FDA Circular of Information: There is also a phrase in there stating that liquid plasma may contain viable lymphocytes (i.e. risk of GvHD). Edit: This is assuming you are using the liquid plasma, never frozen (26 day expiration), and not thawed plasma (5 day).

And labeled with Rh/K typing, right? Very jealous!

I can only answer the first question. At my previous facility we would order c=, E= units for patients with anti-c, but if the patient only had anti-E we would not order c= on a routine basis. It was not our practice to test the patient for the c antigen if the antibody suspected was anti-E (edit: except during the situations below), so we would not usually know the patient's c typing anyway. Exceptions to this general rule would be patients with a history of sickle cell anemia (we gave Rh/K matched at least) and patients with warm autos who were being frequently transfused. If I had to guess, my supervisor would also make an exception for other frequently transfused patients who were c= (i.e. aplastic anemia or similar) who had anti-E.

My previous hospital used to do this but I believe having a designee was actually not allowed per state laws. Might be something to check on. Besides the potential legal ramifications, having a designee sign makes the form a bit less watertight if anything should happen to the patient. If it's the physician signing, they can't wiggle out of it if the patient ends up having an antibody and a subsequent reaction, etc. That said, if it's worked for 20 years perhaps there's no point trying to change it.

OUCH -- that hurts. We were actually told by our supplier that rotating platelets was not efficient for them, and they would rather us let them expire on our shelf and give us credit. Does not seem like very good stewardship of the blood supply to me, but it was their choice. I think something like this would be really valuable at my current facility considering we are keeping 6-8 platelets on our shelves at a time. We have heavy users in trauma, oncology and cardiac cases. Some nights we throw away four or five. Unfortunately today is my last day here but I'll be keeping an eye out for info to send to my supervisor about this.

Well, as I said, we do not have OB, and we do not take OB traumas except to stabilize them, there is another trauma center about 45 minutes away that does OB, so they take those patients.

We keep it in the fridge because the storage temperature is 2-8C on the package insert. It is diluted and warmed to 37C when time to use it... I think you are incorrectly assuming every fetal stain kit is the same. You seem to be misinterpreting the use of the screening kit. The fetal screen kit does not tell you how much anti-D to give at all, it simply screens for the presence of a bleed. As I said, they are used for two different situations. Here, I will attach the package inserts for the two tests. Based on the times for each step in the stain kit, it can easily take 30 minutes. Fetal stain kit - 285.pdf Fetal screen kit - 3047.pdf

For us it ends up taking that long, considering we do not have the stain out, the buffer has to warm, we have techs who work blood bank only trying to make decent smears and everyone has to pull out the procedure because we do them maybe once a year. The fetal screen kit is not a quantitative test.

I have always used MediaLab from LabCE for my CEUs, it is probably not the cheapest option but it is very convenient for Florida and I've been using it since college. You get unlimited CEUs for a year for I think $95, and it's all online, with the option to print the course material if you would like. I've always finished my Florida CEUs in a couple days at work during downtime, I find their website easy to use and everything automatically 'flips over' to the state's website and will mark you as 'complete' when you have all the hours. The HIV, med errors and related laws CEUs are available there as well.

A fetal screen is essentially adding a weak anti-D to patient cells and incubating; the Immucor kit is a 5 minute RT incubation now, I believe. Then wash and add indicator cells to form rosettes, if the test is positive, and count them. Far easier than a KB. A lot of things are simple that aren't easy. I'd take a 15 minute process over a 30 minute one any day, and skip staring through a scope for very long. Edit: That said, they definitely test for different things! We dumped fetal screens because they too situational for us to stock the kits.

Someone please tell our administration this!

Sigma-Aldrich. We used to use Simmler and were told we could no longer purchase the stain from them as they were not a contracted vendor. Surprise, we never had any issues with them. I sent Sigma-Aldrich's technical support an email asking for suggestions and was told to add a rinse step (?????) at a point in the procedure... when I checked the package insert again, there is ALREADY a rinse step at that point. Considering that our problem is that we cannot distinguish the edges of the maternal cells (with Simmler they stained a nice pale pink, the Sigma stain leaves basically no color in them), adding an extra rinse didn't seem to make much sense to me. We could not tell if we were reading an appropriate field because we couldn't see if cells were overlapping or too far apart. We got frustrated and stopped messing with it for this go-around. Next time maybe the staff will play with it more, but hopefully I'll be at another facility by then and won't have to touch KBs ever again.

Ours are done for trauma patients only, so we do not perform fetal screens at all and they are not sent out. We do them in blood bank and get maybe 2 a year, max. We had so much trouble with our CAP survey this year, once it was submitted we repeated it quite a few times trying to get a decent looking slide and just got nowhere. It's an incredibly frustrating test for us.

It's going to detect ABO incompatibility if the right patient was drawn. Our practices are meant to prevent transfusion of ABO incompatible blood due to wrong blood in tube (WBIT) incidences. Edit: If you are concerned only with patients who qualify for electronic crossmatch then that is slightly different issue, to be sure. I do not think everyone in this thread is using this information for EXM purposes only, though.

If the patient was drawn at one hospital and transfused at the other facility, we just transfer the specimen and change the performance site of the workup as necessary. If they were transfused at our sister hospital this would probably have to occur even if the patient was not transferred, as we don't currently staff a blood banker over there past 3 p.m. In that case, we'd transfer everything, pre and post samples, urine, any bags and tags returned, etc. so the workup could be performed over here.

We do not reconfirm units sent to or from our sister hospital because they do not leave the LIS inventory. Different licenses, same supervisor, same hospital system.

At some point you have to trust nurses if you are going to allow them to draw samples, no? I am not sure I would be comfortable sending a tube that is pre-labeled in any way, but if they are willing to label and verify a draw I see no problems using it. Have you tried using previously collected samples at all? Using hematology and coag tubes has worked very well for us so far. We are generally able to find a CBC from the previous shift on every patient, with exceptions being patients who were just admitted through the ED that day.

Yes, we do, but only for massive transfusion. The AABB Circular of Information states the following: In an extreme case we would use it for emergency release if we needed, but we keep two thawed AB plasmas for that use (and in the case of pediatric traumas).

No reagents, nothing to QC daily, as far as I know. Just make sure your centrifuge optimum spin is done for immediate spin.